Obstructive Airway Disorders

Chronic obstructive pulmonary disease (COPD)

Definition
According to GOLD 2013, COPD is a common preventable and treatable disease, characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lungs to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients1. COPD actually comprises two related diseases, Chronic Bronchitis and Emphysema. Patients with COPD have features of both conditions, although one may be more prominent than the other.

Prevalence
The latest estimations state that more than 340 million people worldwide are affected by this condition1. The prevalence of COPD stage II or higher is 10.1% overall: 11.8% for men, and 8.5% for women. COPD is widely under-diagnosed and under-treated in many parts of the world. COPD prevalence is increasing and represents the fourth leading cause of death after neurovascular, heart, and infectious diseases. COPD was the sixth most common cause of death worldwide in 1990 and predicted to be the third most common cause by 20201.

Patient Profile
COPD is mainly prevalent in men and women between the ages of 45 and 75 with a history of smoking or exposure to environmental pollutants.

Chronic/Long-Term Ventilation Indications
The indication for long-term ventilation support for a COPD patient is often associated with the hypercapnia level, nocturnal hypoventilation and additional patient clinical conditions:

Definition
According to WHO, Cystic Fibrosis is a genetic disorder that affects the respiratory, digestive and reproductive systems involving the production of abnormally thick mucus linings in the lungs and potentially leading to fatal lung infections. The disease can also result in various obstructions of the pancreas, hindering digestion. An individual must inherit two defective Cystic Fibrosis genes, one from each parent, to have the disease. Each time two carriers of the disease conceive, there is a 25% chance of passing Cystic Fibrosis to their children, a 50% chance that the child will be a carrier of the cystic fibrosis gene, and a 25% chance that the child will be a non-carrier. The mucus-producing glands in the airways of the lungs produce abnormal secretions that clog the airways and allow bacteria to multiply. The sweat glands and parotid glands (small salivary glands in the cheek) secrete fluids containing more salt than normal. Generally, the lungs are the most important organs involved – more than 90% of these patients die of respiratory failure.

Prevalence
The prevalence of Cystic Fibrosis varies among different ethnic groups and countries (from 0.7 per 100,000 to 50 per 100,000);
CF is most common among Caucasians and Ashkenazi Jews. Although it is severely underdiagnosed in Asia, existing evidence indicates that the prevalence of CF is rare. In the European Union one in 2000-3000 newborns are found to be affected by CF. In the United States of America, the incidence of CF is reported to be one in every 3500 births.

Approximately 30,000 Americans have CF, making it one of the most common life-shortening inherited diseases. CF is the most common lethal inherited disease in white persons1.

Patient Profile
Cystic Fibrosis is mainly prevalent throughout the first life stages until young adulthood, with an average life expectancy of around 37 years2.
There is no cure for CF, and most individuals with CF die young — many in their 20s and 30s from lung failure. Ultimately, lung transplantation is often necessary as CF worsens2.

Chronic/Long-Term Ventilation Indications
The indication for long-term ventilation support for a Cystic Fibrosis patient is often associated with lung function parameters, hypercapnia levels and nocturnal hypoventilation3.

Diffuse bronchiectasis

PaCO2 > 50 mmHg

Involvement > 3 lobes

FEV1 < 50% (predicted)

FEV1/FVC < 70%

In addition to typical bacterial infections, individuals with CF more commonly develop other types of lung disease.

Bronchiectasis

Definition
Bronchiectasis is characterised by irreversible dilation and damage to the bronchial walls and can be caused by a myriad of underlying conditions. Despite a detailed evaluation, the cause remains undetermined in approximately 50% of cases. In the past, Tuberculosis, whooping cough and measles were the most significant causes of Bronchiectasis. Nowadays postinfectious Bronchiectasis is less frequent in developed countries.

Prevalence
In a study from the USA, the calculated prevalence was 52/100,000 adults. Prevalence was higher in women of all ages 1.

Patient Profile
Data provided from the United Kingdom indicates that 78% of patients afflicted by Bronchiectasis who seek medical treatment are hospitalised and one third have at least one annual exacerbation that requires hospitalisation lasting for an average of 10.5 days. Higher than that estimated for other diseases such as asthma and COPD2. To conclude, in another study it was noted that 25% of the patients died within the 9 years following the first hospitalisation during which Bronchiectasis was detected3.

Chronic/Long-Term Ventilation Indications
The indication for long-term ventilation support for a patient with Bronchiectasis is often associated with lung function parameters, hypercapnia levels and nocturnal hypoventilation.

To enhance your user experience and to deliver our online services, this website uses cookies for reasons of functionality, comfort and statistics. By continuing to browse the site, you are agreeing to our use of cookies.